Provider Demographics
NPI:1497006639
Name:NSH CANCER INSTITUTE PROFESSIONAL SERVICES A LLC
Entity Type:Organization
Organization Name:NSH CANCER INSTITUTE PROFESSIONAL SERVICES A LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ADMIN SERVICES AND CCO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-851-6378
Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:CENTER POINT I, SUITE 510
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7813 SPIVEY STATION BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2900
Practice Address - Country:US
Practice Address - Phone:770-507-0070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX ID
GA6720960004Medicare PIN